Objective:To investigate the clinical effects of autologous platelet rich plasma gel (PRP) combined with vacuum sealing drainage (VSD) technology on the repair of refractory wounds.Methods:From March 2011 to January 2015, 44 patients with refractory wounds and conformed to the inclusion criteria were included into VSD alone group, who were admitted to the Department of Burn and Plastic Surgery of the Yidu Central Hospital of Weifang and received intermittent VSD treatment. From February 2015 to September 2019, 43 patients with refractory wounds and conformed to the inclusion criteria were included into PRP+VSD group, who were admitted to the same unit above-mentioned and received PRP combined with intermittent VSD treatment.The retrospective cohort study was conducted. There were 24 males and 20 females with ages of (37.5±2.2) years in VSD alone group, and there were 25 males and 18 females with ages of (37.0±2.5) years in PRP+VSD group. The wound secretions of patients in the two groups before and 7, 14 d after the first treatment were collected for bacterial culture, and the positive rate of bacterial culture was calculated.The wound healing of patients in the two groups was observed on 7, 14,and 21 d after the first treatment, and the wound healing rate was calculated. The complete wound healing time of patients in the two groups was recorded. The degree of wound pain of patients in the two groups was evaluated by the visual analog scale (VAS) before and 14 d after the first treatment. The scar hyperplasia of patients in the two groups was evaluated by the Vancouver Scar Scale (VSS) in 1 and 2 months after the wound healed completely.The incidence of adverse reactions of patients in the two groups after the treatment was observed and the incidence of adverse reactions was calculated.Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, paired t test, and Bonferroni correction.Results:The positive rates of bacterial culture of patients in PRP+VSD on 7 and 14 d after the first treatment were 37.2% (16/43) and 11.6% (5/43), which were significantly lower than 56.8% (25/44) and 29.5% (13/44) in VSD alone group, χ2= 4.212, 4.255, P<0.05. The wound healing rates of patients in PRP+VSD group on 7, 14 and 21 d after the first treatment were (58±14)%, (70±13)%, (89±12)%, which were significantly higher than (41±11)%, (60±11)%, (74±12)% in VSD alone group, t=6.323, 3.820, 5.751, P<0.01. The complete wound healing time of patients in PRP+VSD group was (30±6) d, which was significantly shorter than (61±8) d in VSD alone group, t=20.89, P<0.05. The VAS score of patients in PRP+VSD group was significantly lower than that in VSD alone group (t=13.904, P<0.01). The VSS score of patients in PRP+VSD group was significantly lower than that in VSD alone group in 1 and 2 months after the wound healed completely (t=3.307, 3.637, P<0.01). The incidence of adverse reactions of patients in PRP+VSD group after the treatment was 7.0% (3/43),which was significantly lower than 22.7% (10/44) in VSD alone group alone, χ2=4.245, P<0.05. Conclusions:Autologous PRP gel combined with VSD technology to repair refractory wounds not only has good bacteriostatic effect, but also can increase wound healing rate, shorten wound healing time, reduce wound pain, relieve scar hyperplasia, and without adverse reactions, which is worthy of promotion.

Objective To analyze the effects of adenohypophysis function after treating with thyrotropin releasing hormone and its clinical significance in patients with brain trauma. Methods There were 22 cases with traumatic brain injuries from July 2010 to September 2012 in Chinese people's Liberation Army nine eight hospital,after injuried within 4 to 12 hours,then 1 1 cases who were given thyrotropin-releasing hormone(TRH)were selected as experimental group,while 1 1 cases who were given the same amount of isotonic saline were selected as control group,then the score of GCS, ICS,RLS85 and the improvement of adenohypophysis function were observed. Results After treatment,the score of glasgow coma scale (GCS ), innsbruck coma scale (ICS),and the reaction level scale (RLS85)between two groups were significantly increased in three days compared with before treatment,and within three days after injury situation,the improvements of ICS and RLS85 in experimental group were better than control group(P<0.05 ). Compared with control group,the levels of each gland pituitary hormone in experimental group were significantly increased(P<0.05 ),and on the third day,the growth hormone (GH)was reduced significantly,finally 50%of that in control group. Conclusion Patients with brain injury treated with thyrotropin releasing hormone,has no significant adverse reactions,with the characteristics of safe and effective.

Objective:With the help of computed tomographic angiography and three dimensional technique, to explore to clinical application of the free scapular flap.Methods:From January 2013 to June 2018, 21 cases of deep post-burn wounds of limbs were repaired with free scapular flaps. 3D-CTA examinations were performed before operation, and the personalized reconstructions were designed according to different shape and size of the defects in the recipient sites. The outcome, color, texture, scar contracture and dysfunction of the flaps were observed.Results:The 3D-CTA technique was able to define the anatomical structure of the donor and recipient area before the operation. During the operation, it was found that the course and distribution of blood vessels were basically consistent with the design before the operation. 21 flaps survived after the operation. During the follow-up of half a year to one year, the color, texture, and appearance of the flap recovered satisfactorily, the function of the affected limb activity recovered, no obvious scar hyperplasia was found in the dorsal donor area, and the function of the shoulder joint was normal.Conclusions:The free scapular flap is one of the ideal methods to repair the deep burn wounds of limbs, which has reliable blood supply, wide range of incision, convenient operation, no damage to the main blood vessels and concealed donor areas. 3D-CTA examination before operation guided the design and implementation of operation scheme, which improved the accuracy of intraoperative vascular anastomosis.

Objective:With the help of computed tomographic angiography and three dimensional technique, to explore to clinical application of the free scapular flap.Methods:From January 2013 to June 2018, 21 cases of deep post-burn wounds of limbs were repaired with free scapular flaps. 3D-CTA examinations were performed before operation, and the personalized reconstructions were designed according to different shape and size of the defects in the recipient sites. The outcome, color, texture, scar contracture and dysfunction of the flaps were observed.Results:The 3D-CTA technique was able to define the anatomical structure of the donor and recipient area before the operation. During the operation, it was found that the course and distribution of blood vessels were basically consistent with the design before the operation. 21 flaps survived after the operation. During the follow-up of half a year to one year, the color, texture, and appearance of the flap recovered satisfactorily, the function of the affected limb activity recovered, no obvious scar hyperplasia was found in the dorsal donor area, and the function of the shoulder joint was normal.Conclusions:The free scapular flap is one of the ideal methods to repair the deep burn wounds of limbs, which has reliable blood supply, wide range of incision, convenient operation, no damage to the main blood vessels and concealed donor areas. 3D-CTA examination before operation guided the design and implementation of operation scheme, which improved the accuracy of intraoperative vascular anastomosis.

Objective:To investigate the clinical effects of autologous platelet rich plasma gel (PRP) combined with vacuum sealing drainage (VSD) technology on the repair of refractory wounds.Methods:From March 2011 to January 2015, 44 patients with refractory wounds and conformed to the inclusion criteria were included into VSD alone group, who were admitted to the Department of Burn and Plastic Surgery of the Yidu Central Hospital of Weifang and received intermittent VSD treatment. From February 2015 to September 2019, 43 patients with refractory wounds and conformed to the inclusion criteria were included into PRP+VSD group, who were admitted to the same unit above-mentioned and received PRP combined with intermittent VSD treatment.The retrospective cohort study was conducted. There were 24 males and 20 females with ages of (37.5±2.2) years in VSD alone group, and there were 25 males and 18 females with ages of (37.0±2.5) years in PRP+VSD group. The wound secretions of patients in the two groups before and 7, 14 d after the first treatment were collected for bacterial culture, and the positive rate of bacterial culture was calculated.The wound healing of patients in the two groups was observed on 7, 14,and 21 d after the first treatment, and the wound healing rate was calculated. The complete wound healing time of patients in the two groups was recorded. The degree of wound pain of patients in the two groups was evaluated by the visual analog scale (VAS) before and 14 d after the first treatment. The scar hyperplasia of patients in the two groups was evaluated by the Vancouver Scar Scale (VSS) in 1 and 2 months after the wound healed completely.The incidence of adverse reactions of patients in the two groups after the treatment was observed and the incidence of adverse reactions was calculated.Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, paired t test, and Bonferroni correction.Results:The positive rates of bacterial culture of patients in PRP+VSD on 7 and 14 d after the first treatment were 37.2% (16/43) and 11.6% (5/43), which were significantly lower than 56.8% (25/44) and 29.5% (13/44) in VSD alone group, χ2= 4.212, 4.255, P<0.05. The wound healing rates of patients in PRP+VSD group on 7, 14 and 21 d after the first treatment were (58±14)%, (70±13)%, (89±12)%, which were significantly higher than (41±11)%, (60±11)%, (74±12)% in VSD alone group, t=6.323, 3.820, 5.751, P<0.01. The complete wound healing time of patients in PRP+VSD group was (30±6) d, which was significantly shorter than (61±8) d in VSD alone group, t=20.89, P<0.05. The VAS score of patients in PRP+VSD group was significantly lower than that in VSD alone group (t=13.904, P<0.01). The VSS score of patients in PRP+VSD group was significantly lower than that in VSD alone group in 1 and 2 months after the wound healed completely (t=3.307, 3.637, P<0.01). The incidence of adverse reactions of patients in PRP+VSD group after the treatment was 7.0% (3/43),which was significantly lower than 22.7% (10/44) in VSD alone group alone, χ2=4.245, P<0.05. Conclusions:Autologous PRP gel combined with VSD technology to repair refractory wounds not only has good bacteriostatic effect, but also can increase wound healing rate, shorten wound healing time, reduce wound pain, relieve scar hyperplasia, and without adverse reactions, which is worthy of promotion.

Objective:To explore the effect of free medial plantar perforator flap in repairing deep burn wound on palm with assistance of three dimensional computed tomography angiography (CTA).Methods:From March 2015 to January 2018, 11 patients with deep burn wounds of palm were admitted to the Department of Burns and Plastic Surgery of Yidu Central Hospital of Weifang City, including 6 males and 5 females, aged 19-53 years. The wound area after debridement was 3.0 cm×2.5 cm-8.0 cm×6.0 cm. Before the operation, CTA of the foot was performed, and the three dimensional digital model was reconstructed by computer software to observe the initial position, course, and distribution of the arteries and veins in the donor site. The medial plantar perforator flap was designed according to the area and shape of the wound, with area of 3.5 cm×3.0 cm-8.5 cm×6.5 cm. After the wound was covered by the flap, the perforating branch of the medial plantar artery was anastomosed end to end with the carpal epithelial branch of the ulnar artery, the accompanying vein or the branch of the great saphenous vein was anastomosed end to end with the accompanying vein of the carpal epithelial branch of the ulnar artery, and the terminal branch of the saphenous nerve or the medial dorsal cutaneous nerve was anastomosed end to end with the superficial palmar branch of the ulnar nerve. The wound of donor site was covered with full-thickness skin graft from the outer thigh of the same side. The perforators of the medial plantar artery observed during the operation were compared with the reconstructed three dimensional CTA images. The survival of flap was observed, and the appearance and function of the flap were followed up and evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association.Results:The initial position, course, and distribution of the perforator of the medial plantar artery during the operation were basically the same as those of the reconstructed three dimensional CTA images before the operation. All the flaps of patients survived after the operation. During the 6 months to 1 year follow-up, the appearance of flap was good, with no obvious swelling or pigmentation, but with good elasticity. The discrimination distance between the two points was 5.0-8.0 mm, and the flaps were evaluated as excellent in 4 cases, good in 6 cases, and fair in 1 case.Conclusions:The free medial plantar perforator flap is an ideal choice for repair of the deep burn wound on palm. Three dimensional CTA before the operation can detect condition of vascular variation, with high accuracy of vascular anastomosis during operation.

Objective:To investigate the clinical effects of autologous platelet rich plasma (PRP) gel in combination with vacuum sealing drainage (VSD) technology in repairing refractory wounds.Methods:From March 2011 to January 2015, 44 patients with refractory wounds meeting the inclusion criteria were recruited into VSD alone group, who were admitted to the Department of Burns and Plastic Surgery of the Yidu Central Hospital of Weifang and received intermittent VSD treatment. From February 2015 to September 2019, 43 patients with refractory wounds meeting the inclusion criteria were recruited into PRP+ VSD group, who were admitted to the same unit as above-mentioned and received PRP combined with intermittent VSD treatment. The retrospective cohort study was conducted. There were 24 males and 20 females with age of (37.5±2.2) years in VSD alone group, and there were 25 males and 18 females with age of (37.0±2.5) years in PRP+ VSD group. The wound exudate of patients in the two groups before and 7 and 14 d after the first treatment were collected for bacterial culture, and the positive rate of bacterial culture was calculated. The wound healing of patients in the two groups was observed on 7, 14, and 21 d after the first treatment, and the wound healing rate was calculated. The complete wound healing time of patients in the two groups was recorded. The degree of wound pain of patients in the two groups was evaluated by the Visual Analog Scale (VAS) before and 14 d after the first treatment. The scar hyperplasia of patients in the two groups was evaluated by the Vancouver Scar Scale (VSS) in 1 and 2 months after the wound healed completely. The occurrence of adverse reactions of patients in the two groups during the whole period of treatment was observed and the incidence of adverse reactions was calculated. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, paired t test, and Bonferroni correction. Results:The positive rates of bacterial culture in wound exudate of patients in PRP+ VSD on 7 and 14 d after the first treatment were 37.2% (16/43) and 11.6% (5/43), which were significantly lower than 56.8% (25/44) and 29.5% (13/44) in VSD alone group, χ2=4.212, 4.255, P<0.05. The wound healing rates of patients in PRP+ VSD group on 7 and 14, and 21 d after the first treatment were respectively (58±14)%, (70±13)%, (89±12)%, which were significantly higher than (41±11)%, (60±11)%, (74±12)% in VSD alone group, t=6.323, 3.820, 5.751, P<0.01. The complete wound healing time of patients in PRP+ VSD group was (30±6) d, which was significantly shorter than (61±8) d in VSD alone group, t=20.890, P<0.05. The VAS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group on 14 d after the first treatment ( t=13.904, P<0.01). The VSS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group in 1 and 2 months after the wound healed completely ( t=3.307, 3.637, P<0.01). The incidence of adverse reactions of patients in PRP+ VSD group during the whole period of treatment was 7.0% (3/43), which was significantly lower than 22.7% (10/44) in VSD alone group, χ2=4.245, P<0.05. Conclusions:Autologous PRP gel combined with VSD technology in repairing refractory wounds not only has good bacteriostatic effect, but also can increase wound healing rate, shorten wound healing time, alleviate wound pain, reduce scar hyperplasia, with less adverse reaction, which is worthy of promotion.

ObjectiveTo analyze the polarized light microscopic characteristics， the composition of physical phases and their relative contents of Maifanitum from different origins， and to establish the Fourier characteristic fingerprint of Maifanitum powder crystals by X-ray diffraction（XRD）. MethodA total of 26 batches of Maifanitum samples were selected， and the microscopic characteristics of the sample powders and grinding flakes were observed by polarized light microscopy under single polarized light and orthogonal polarized light， and the main phase compositions and their relative contents were analyzed by powder crystal XRD technique， and the XRD Fourier characteristic fingerprint of Maifanitum was established. The incident light source of XRD was Cu target Kβ radiation， the light tube voltage and light tube current were 40 kV and 40 mA， respectively， the divergence slit was 1°， the scattering slit was 1°， the receiving slit was 0.2 mm， the scanning speed was 5°·min^-1 with continuous scanning and scanning range of 5-90°（2θ）， and the step length was 0.02°. ResultThe polarized light micrographs of powders and grinding flakes of Maifanitum were obtained， and the main phases were plagioclase， potassium feldspar and quartz， and a few samples also contained illite， pyrite， iron dolomite， calcite， iron amphibole and chlorite， etc. The relative total content of feldspar phases was 61.9%-82.4%， and the relative content of quartz was 12.6%-33.6%. The XRD Fourier fingerprint analysis method of Maifanitum with 13 common peaks as the characteristic fingerprint information was established， and the similarity calculated by the mean correlation coefficient method was 0.920 9-0.997 7， the similarity calculated by the mean angle cosine method was 0.940 5-0.998 4， the similarity calculated by the median correlation coefficient method was 0.921 1-0.997 5， and the similarity calculated by the median angle cosine method was 0.947 5-0.998 2. ConclusionThe polarized light microscopic identification characteristics of Maifanitum are mainly plagioclase， quartz and potassium feldspar， and the technique of powder crystal XRD Fourier fingerprint analysis can be used for the identification of Maifanitum.

Central nervous system (CNS) injuries, including stroke, traumatic brain injury, and spinal cord injury, are essential causes of death and long-term disability and are difficult to cure, mainly due to the limited neuron regeneration and the glial scar formation. Herein, we apply extracellular vesicles (EVs) secreted by M2 microglia to improve the differentiation of neural stem cells (NSCs) at the injured site, and simultaneously modify them with the injured vascular targeting peptide (DA7R) and the stem cell recruiting factor (SDF-1) on their surface via copper-free click chemistry to recruit NSCs, inducing their neuronal differentiation, and serving as the nanocarriers at the injured site (Dual-EV). Results prove that the Dual-EV could target human umbilical vascular endothelial cells (HUVECs), recruit NSCs, and promote the neuronal differentiation of NSCs in vitro. Furthermore, 10 miRNAs are found to be upregulated in Dual-M2-EVs compared to Dual-M0-EVs via bioinformatic analysis, and further NSC differentiation experiment by flow cytometry reveals that among these miRNAs, miR30b-3p, miR-222-3p, miR-129-5p, and miR-155-5p may exert effect of inducing NSC to differentiate into neurons. In vivo experiments show that Dual-EV nanocarriers achieve improved accumulation in the ischemic area of stroke model mice, potentiate NSCs recruitment, and increase neurogenesis. This work provides new insights for the treatment of neuronal regeneration after CNS injuries as well as endogenous stem cells, and the click chemistry EV/peptide/chemokine and related nanocarriers for improving human health.